Brain disease is linked to soccer, raises questions about headers

For the first time, a soccer player is a named case of having chronic traumatic encephalopathy (CTE), a degenerative brain disease linked to repeated blows to the head.

Researchers in Boston identified CTE in American soccer player Patrick Grange, who died at the age of 29 after being diagnoses with amyotrophic lateral sclerosis (ALS). A deceased rugby player was also identified with CTE. The New York Times first reported the story.

Dr. Ann McKee, the neuropathologist who examined Grange's brain, told The Times that Grange had extensive frontal lobe damage normally seen in football players. McKee said the damage to his brain corresponded to the part of the head where a soccer player would use for headers, but McKee cautioned against concluding repeated headers caused CTE.

"We can't say for certain that heading the ball caused his condition in this case," McKee told The Times. "But it is noteworthy that he was a frequent header of the ball, and he did develop this disease. I'm not sure we can take it any further than that."

Doctors said Grange's autopsy showed he died from Stage 2 CTE with motor neuron disease. Stage 4 is the most severe level of CTE. Four years ago, McKee linked CTE to the development of a motor neuron disease that has been found in 15 other athletes. A 2013 study by the National Institute of Occupational Safety and Health found that former NFL players who played at least five seasons were four times more likely to develop a motor neuron disease.

Although soccer has received less media attention than football regarding concussions, there is concern in the medical community about soccer's subconsussive hits, which can accumulate over time just as in football.

A recent University of Washington study of girls soccer players from ages 11 to 14 found that 13 percent of those athletes suffered a concussion each season. More than half of those concussed players continued playing after the injury.

Head injuries in soccer can occur multiple ways, such as collisions, elbows to the head, and falling to the ground. An NCAA study reported that nearly half of the college soccer concussions recorded from 2009 to 2011 resulted from contact with another player's head, elbow or foot.

Increasingly, researchers are studying the impact heading the ball has on the brain.

One study last year by Einstein's Gruss Magnetic Resonance Research Center in New York looked at differences in fractional anisotropy (FA) -- the water movement through the brain -- between soccer players who head the ball frequently and those who don't. Low FA means there has been axon damage, which is normally coupled with cognitive impairment in patients who have had a traumatic brain injury.

That study of players in their 30s found that those who headed the ball between 885 to 1,550 times a year had significantly lower FA in three areas of the brain. Players with more than 1,800 headers per year also had lower memory scores compared to players with fewer headers. Some researchers have cautioned that studies shouldn't put a cloud over the sport of soccer.

Grange was a lifelong soccer player who played in college at Illinois-Chicago and New Mexico and then for the Chicago franchise of the Premier Development League.

"Every park you go by, kids are playing soccer," Michele Grange, the player's mother, told The New York Times. "And they're doing headers. And that really bothers me. When I see the little kids playing soccer, even my grandson, for one thing it reminds me of better days. But on the other, it makes you think of the consequences. And I hope that these kids and their parents are going to see to it that they take care of their heads."